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Title: Mineral adaptations following kidney transplantation
Austin Authors: Tan, Sven-Jean;Crosthwaite, Amy;Langsford, David;Obeysekere, Varuni;Ierino, Frank L;Roberts, Matthew A;Hughes, Peter D;Hewitson, Tim D;Dwyer, Karen M;Toussaint, Nigel D
Affiliation: Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
Department of Nephrology, Northern Hospital, Epping, Victoria, Australia
Department of Endocrinology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Victorian Kidney Transplantation Collaborative, Melbourne, Victoria, Australia
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
School of Medicine, Deakin University, Geelong, Victoria, Australia
Issue Date: 5-Mar-2017 2017-03-05
Publication information: Transplant International 2017; online first: 5 March
Abstract: Klotho is predominantly expressed in the kidney and reported to have antioxidant and antifibrotic properties. Soluble Klotho (sKl), the circulating protein cleaved from membrane-bound Klotho, is reduced significantly with kidney disease and inversely associated with mortality. sKl has not been thoroughly evaluated prospectively after kidney transplantation. Incident kidney transplant recipients (KTRs) were prospectively evaluated pretransplantation, 1, 12 and 52 weeks post-transplantation. Basic biochemistry, sKl and intact FGF23 were measured. Within-subject comparisons were evaluated using repeat-measure anova or Friedman's analysis. Effects of immunosuppression and biochemical parameters on sKl and FGF-23 over time were analysed using mixed-effects modelling. Median serum creatinine (sCr) at 1 week was 116 (92-142) μmol/l, and at 52 weeks, all 29 KTRs had a functioning graft with median sCr of 111 (97-131) μmol/l. Compared with baseline, sKl was increased at 52 weeks following an initial decline at 1 week (P < 0.005 and P < 0.01, respectively), while FGF23 was considerably reduced at 52 weeks (P < 0.001). In a mixed-effects model, an increased sKl was not associated with reduction in immunosuppression or evaluated biochemical parameters. Modest increase in sKl is observed one-year postkidney transplantation with excellent early graft function suggesting factors beyond renal capacity may influence circulating sKl. FGF23 normalization was observed. Longer term evaluation in transplantation, specifically addressing the effects of immunosuppression, is required to understand the pathophysiology of the sKl/FGF23 axis and potential for modification.
DOI: 10.1111/tri.12925
PubMed URL:
Type: Journal Article
Subjects: Fibroblast growth factor-23
Kidney transplant recipient
Soluble Klotho
Appears in Collections:Journal articles

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